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PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> 209/468-3420 <br /> ,,AAUNDERGROUND TANK P('ROGRAM OFFICIAL INSPECTION REPPOrRT/_ <br /> Facility NameCJ6*9i J� '1;1 � J� acility ID rZ 3 6 p Cps <br /> Facility Address e City zip, <br /> Facility Phone #_,alp - ([ acility Contact <br /> Inspection Date: - Inspection Type: <br /> UST: Dual Wall_ Single Wall OVERFILL: Audible_ -Visual Mecrianical <br /> UST Monitoring Alternative UST Content - '� �-- <br /> PIPING SYSTEM: Dual Wall Single Wall Suction Pressure Gravity <br /> Does the leak detection system shut off the pump automatically? YES_ NO_ <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS _ <br /> Permit to Operate [H&S 25284] r p, <br /> orms A & B curren c <br /> Monitoring/Maintenance Records <br /> 27TTTB7T- <br /> Financial Response i ity LH&S 2b292.2 (a) ] <br /> -Monitoring Recoras Availanle L��3CCR 2112J <br /> monitoring P.Lan <br /> Response Plan L23CCR 2632 (d) (2) ] <br /> UnautnorizeCL Reeases Re Orr CL H& 252951 <br /> Monitoring Equipment Annua Test L23CCR 2630 <br /> ver spill on ainer L23CCR 2=(531 <br /> Permitted UST Repairs L23CCR 2661 <br /> Permitted Upgrades [23CCR 2660] <br /> Cathodic ro ec ion a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Integrity Test [23CCR 2643.1] <br /> Annual MIR Report 23CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Daiiv Stickreadinq L23CCR 44 c 1 <br /> Gauging Stick in 1/8 inches [23CCR 2646 (c) (1) (E) ] <br /> STATISTICAL INVENTORY RECONCILIATION SIR <br /> Excessive Variation Reported 23CCR 2646.1 (d) <br /> usr integrity es ever wo ears <br /> Annua SIR Report 23CCR 2646.1 <br /> ai y Stick Reaaing L23UUR 2,b4b kc) kl) ] <br /> AUTOMATIC TANK GAUGING ATG <br /> Mo ly ATG Results [3CCR 2643 (b) (1) ] <br /> Annua ATG Summar Report 23CCR 2712 b 2 <br /> MANUAL UST TANK GAUGINGMT <br /> Tank Gau in Weekl [23CCR 2645 (b) ] <br /> Annual <br /> nnua Tan Integrity Test 23CCR 2645 <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring [23CCR App.III <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity i ing Tested every 2 years e <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annual ea etec or test L23CCR App.lV(1) (d) J <br /> SYSTEM STATUS: Major Violations No Violations � /� <br /> COMM S: <br /> i ST 0-4eqJ <br /> REHS: RECEIVED BY: <br /> TITLE: (�1 f PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />